PB2122: THE EFFICACY OF THE STANDARD AND INTENSIVE CHEMOTHERAPY IN ELDERLY PATIENTS WITH DOUBLE- AND TRIPLE-EXPRESSOR LYMPHOMA.
Authors: M. Fujita, H. Itamura, M. miyazaki, K. Ishii, A. Sugihara, H. Sano, S. Okamoto, M. yoshimura, H. Katsuya, H. Ureshino, T. Ando, S. Kimura
Journal: HemaSphere (2022)

Background: Overexpression of c-myc and bcl-2 and/or bcl-6 in diffuse large B-cell lymphomas, defined as double-expressor lymphoma (DEL) and triple-expressor lymphoma (TEL), are considered to have a poor prognosis. These patients using intensified chemotherapy have been tried to achieve therapeutic efficacy and prolong their prognosis. Although several clinical data have been reported, the requirement of intensive chemotherapy, including dose-adjusted R-EPOCH (DA-R-EPOCH), for DEL and TEL is still controversial. Primarily, there seems to be insufficient analysis in elderly patients over 70 years old, which is the preferred age for malignant lymphoma. Aims: To reveal the efficacy of dose-intensifying regimens in managing DEL and TEL, we analyzed data comparing the outcomes of R-CHOP and DA-R-EPOCH as frontline therapy. Methods: We retrospectively analyzed the 37 of DEL and TEL patients diagnosed from January 2017 to December 2021 using R-CHOP versus more intensified treatment, DA-R-EPOCH. Formalin-fixed and paraffin-embedded tissues were constructed for immunohistochemistry (IHC). Statistical analyses were performed using the Kaplan-Meier method and log-rank test. Univariate and multivariate analyses were conducted via the Cox proportional hazards model, and it took p values lower than 0.05 to be significant. Results: The median age in the patients with DEL and TEL was 71.3 (range, 56-88). Moreover, the patients aged 70 years old over were 56 %. Twelve patients were diagnosed in DEL, and twenty-five patients were TEL, respectively. In DEL and TEL patients, twenty-one patients (60%) are received R-CHOP, and 14 patients (40%) were treated DA-R-EPOCH, respectively. The patients in Stage III-IV were 73%. GCB types were constituted 18 cases (48.6%). Fifteen patients (40.5%) diagnosed with DEL and TEL were received central nervous system (CNS) prophylaxis. The progression-free survival (PFS) was equivalent when comparing the TEL and DEL patients, respectively. Two-years PFS with R-CHOP vs DA-R-EPOCH for the overall population were 52.6% (95% confidence interval [CI], 21.7-76.2) vs 49.6% (95% CI, 14.8-77.3), respectively. The overall response rates and complete response rates for R-CHOP were 93% and 46%, and for DA-R-EPOCH were 90% and 60%, respectively (Figure A). Especially, over 70 years old patients with DA-R-EPOCH showed poor prognosis than DA-R-EPOCH in younger patients, although the PFS with R-CHOP has no difference between aged patients or not (Figure B). Furthermore, the patients with the drug discontinuation or dose reduction in DA-R-EPOCH treatment were tended to indicate poor PFS outcomes than the rest of the patients (Figure C). Image:Summary/Conclusion: Our finding is consistent with the fact that R-CHOP and R-EPOCH showed a similar prognosis in patients with DEL, and the association of aged TEL with intensive therapy confers earlier relapses of this variant DLBCL, requiring more appropriate treatment. It might be considered about the therapeutic approach for DEL and aged TEL patients whether required the intensive therapies or not.